Organization
FAYETTEVILLE STREET COMMUNITY LIVING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN ARTIS WILLIAMS (ADMINISTOR)
(919) 519-0016
Entity
Organization
Contact information
Practice address
111 N MAPLE ST, DURHAM, NC 27703-3021
(919) 519-0016
(919) 596-0645
Mailing address
111 N MAPLE ST, DURHAM, NC 27703-3021
(919) 519-0016
(919) 596-0645
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL032445
NC
Other
Enumeration date
07/02/2008
Last updated
12/12/2013
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